Delivering Telehealth Rapidly with Epic
Healthcare Triangle
Mar 31, 2020
Arm Your Frontline with Tools to Monitor, Diagnose, Manage, Treat, and Prevent the Spread of COVID-19
Health entities across the United States are rushing to address, mitigate, and take action against the evolving COVID-19 pandemic, and while impacts of the virus already weigh heavily on the supply chain and frontline health professionals, the need for immediate and scalable telehealth solutions is in the IT limelight now as well.
With the volume and risk of COVID-19 cases expanding across the US, telehealth technology is not only now relevant, but absolutely essential for combatting the virus. Provider-to-patient telehealth and other remote/distancing measures need to be of paramount focus across the country in order to stem the tide, contain exposure, and proactively manage the virus.
Epic offers a variety of invaluable telehealth features that all their organizations can take advantage of, along with new content and tools designed specifically for COVID-19. While the ability to adopt and scale some of the Epic features in mass is ultimately dependent on infrastructure, server capacity, and organizational communication, they can all be “turned on” and made available to staff and patients with minimal effort. Those in the greatest need of the tools can start using them immediately.
Let’s dive in and take a look at each of the features available to the Epic community for use during these challenging times.
MyChart & eVisits
- You may have already seen the influx of specialized mobile apps in response to COVID-19 related needs, along with a host of other medical screening and tracking tools. These new options fill an important role in organizational surge protection and proactive risk mitigation via forward-triage methods. While there are now many options for patients to quickly gauge risk and determine next steps, Epic makes the same patient screening and next-step functions available via MyChart. Questionnaires can be seamlessly pushed to patients in mass, and integrated automatically with the medical record, with notifications to relevant care providers.
- Based on these questionnaires (Epic provides one for COVID-19 or you can customize/create your own), and follow-up questions or needs that arise, an eVisit can be easily generated for back-and-forth secure communication between patient and provider. Once the electronic visit is established, media files can also be shared securely. It is an easy and convenient way to communicate about matters that are determined non-urgent, rather than coming into clinic to reach that decision.
- The AHA, in connection with Jefferson Health, has cited that 80% of urgent/emergent visits scheduled virtually resolve the concern at hand without the need for an in-person trip.
Direct Screening & Triage
- Schmitt-Thompson Clinical Content has partnered in the effort against COVID-19, allowing Epic to distribute relevant triage content without licensing fees or restrictions. You can use the Schmitt-Thompson COVID-19 protocols whether or not you are licensed for their content, and can upload them into your Nurse Triage screens, as well as distributing by PDF for use at phone banks.
- Epic also provides updated travel screenings and rule-in/rule-out questionnaires, along with relevant best practices for isolation and infection follow-up steps for your clinicians on the front lines, whether corresponding with a patient in-person or remotely. With the click of an order set, all the necessary precautions, notifications, and tests/next steps can be automated.
- Finally, for those areas exposed to a heavy influx and volume of patients, Epic has quick registration options to mitigate surge and help to expedite drive-through testing.
Video Conference Visits (integrated with 3rd party video vendors).
- Epic provides several mechanisms specifically designed for video-conferencing visits. With the impact of volume already weighing on a number of organizations, and with the social-distancing measures being employed amidst the COVID-19 outbreak, staff can convert previously scheduled in-person appointments to video visits, set up visits for new and urgent video consult needs, and even configure on-demand queues for patients to wait in line to receive immediate face-to-face attention and care.
- The patient can connect to the video conference visit seamlessly through MyChart web or mobile, and the clinician can connect through Hyperspace, Haiku for iOS, or Canto. Once these visits are initiated, the clinician and the patient interact through live audio and video, and documentation occurs on the patient's chart just like a regular office visit.
- The “on-demand” queues function in the same manner but instead of engaging through a scheduled appointment, the patient is added to a real-time queue, for which designated telehealth providers at the organization can see information about and one-by-one open the video feeds to begin correspondence. This can be done across organizational boundaries as well, through EpicCare Link or Community Connect partnerships, minimizing the time it takes patients to get help with their concerns.
- Epic has existing integration with a number of common telehealth video communication vendors deemed secure and HIPAA compliant, but with recent announcements from Health & Human Services expanding regulation to accommodate "any non-public facing remote communication product that is available to communicate with patients" even non-standardly supported options can be leveraged.
Tracking & Monitoring the Population
- In addition to the direct telehealth tools mentioned above, Epic has robust options for tracking and managing at both the individual and population levels. For the duration of the COVID-19 outbreak, it is critical to be accurately tracking during and after potential exposure to COVID-19.
- The first tool you should be leveraging is one of the newest - the CDC's Person Under Investigation (PUI) form - which is required to be submitted to state health agencies along with a Case Report for every person being tested. Epic has converted this to a fillable/checkbox version that can be embedded into your clinical workflows and displayed prominently anywhere on screen in the system.
- Epic automatically makes available new diagnosis codes, and standard features including result components, groupers, flowsheets, order sets, and smartdata elements should be leveraged to track and monitor all patients presenting for COVID-19 reasons/testing.
- Using your version of those mechanisms, you can configure a COVID-19 specific Pulse Dashboard, to help your managers and other leaders monitor relevant visit information, safety/compliance, and the status of test results.
- For organizations with high demand, emergency needs, Capacity dashboards that include information on available ICU beds and ventilators are also available.
- Finally, Epic’s Slicer Dicer tool and the COVID-19 Population Explorer dashboard can be used by anyone looking to drill down for more information or trends pertaining to a given region, population, or subset of information.
Telehealth Billing & Reimbursement
- While Epic has always had everything you need to bill properly for telehealth services, the federal government has relaxed restrictions for the duration of the pandemic, and many private payers are following suit as well. While entities in the private sector likely each have their own policies and requirements for you to understand, a few specific modifications to existing Epic functions can at least immediately ensure that you will obtain maximum CMS reimbursement.
- Use or create a specialty billing indicator that can be applied to all COVID-19 patient accounts.
- Use or create rules to stop billing and send all COVID-19 accounts to a Workqueue for review, ensuring that video visit billing has the proper place of service code(s) listed, along with appropriate COVID-19 reason for visit, diagnoses, and any modifiers or additional documentation your private payers may need.
- Consider holding the claims as well until both the state and federal submission and reimbursement rules have been clearly defined and communicated.
- You may consider a rule in Epic to temporarily hold patient statements for these telehealth visits as well, for the same reasons.
- Lastly, Epic’s charge router and charge handler actions can be used to automatically address any unique circumstances that you may have or come across specific to COVID-19 and the telehealth services you are providing.
Some locations have been seeing more than a 10x surge in requests and needs for telehealth since the outbreak of COVID-19, making it crucial to have the above system mechanisms in place and available to staff ASAP. The goals are the same everywhere - to provide our frontline healthcare teams with the tools and safety they need to effectively diagnose and manage the patient influx, to prevent the further spread of COVID-19, and to track, treat, and monitor all who are affected. Telehealth is rapidly becoming a literal lifeline for many, and the faster and more efficiently we get it deployed, the better everyone will be.
For further discussion or assistance with any of what has been outlined here, from video vendor options to billing logic and setup, feel free to contact. I’m connected with a number of Epic teams across the country and resources already hard at work advising, executing, and advancing these options for organizations large and small.